Pain Physicians: What Procedure Was Most Helpful for Your Patients in 2011?

Abby Callard -  
Five pain management physicians discuss what procedures have been the most beneficial for patients in their practice in 2011.

Laxmaiah Manchikanti, MD, Pain Management Center of Paducah (Paducah, Ky.): I'm a believer in the proven procedures rather than the unproven cutting edge technology. Epidural injections are the most helpful procedure for therapeutic purposes, and facet joint blocks are the most helpful for both diagnostic and therapeutic purposes.

Lora L. Brown, MD, Coastal Pain and Rehabilitation (Bradenton, Fla.): A relatively new procedure called MILD, for the treatment of lumbar canal stenosis, has been a breakthrough remedy for many of my patients. This fluoroscopy guided, percutaneous approach allows the physician to decompress enlarged ligamentum flavum tissue posteriously while creating space in the spinal canal. This interventional procedure affords many people a viable, non-surgical option for the treatment of LSS. In many people who are non-surgical candidates due to multiple serious medical conditions, this affords them a treatment alternative.

Neil Kirschen, MD, Pain Management Center of Long Island (Rockville, N.Y.): The best treatment that I can offer patients in general would still be epidural steroid injections. For people with acute and sub-acute pain, injecting anything around the nerve root, it is still dollar for dollar the best way to get someone to feel better. I couldn't practice without that modality. It's been the staple for many years, probably more than 40-50 years already. We've made the technique better by doing it under fluoroscopic guidance. There's no pill still that’s been able to replace what the epidural steroid injections can do around the nerve roots.

Gennady Gekht, MD, Coastal Pain and Rehabilitation (Bradenton, Fla.): Spinal Cord Stimulation. It is not the most frequent procedure; I would say that this is the rarest thing that we do. In a lot of ways I think of it as a procedure that almost salvages someone from pain. Because of the way this procedure is done, a trial phase and then a permanent phase, patients can tell you whether or not the procedure was helpful. When this procedure was helpful, they report more than a 50 percent improvement in pain. It's a very gratifying experience to see these patients come in after a day of the trial period and tell you that their pain is 50 percent better. In a lot of cases they report a 70-90 percent improvement.

Frank J. E. Falco, MD (Mid Atlantic Spine, Bear, Del.): Spinal cord stimulation, IT pump therapy, peripheral nerve stimulation, IV Ketamine therapy and endoscopically assisted discectomies have provided great satisfaction to our patients by providing profound pain relief, the reduction and/or elimination of opioid pain medications, improved quality of life and increased physical function.

This is an ongoing series which will feature five pain management physicians' responses to questions about the specialty.

Next week's question is: What is the most important technology or practice management tool pain management practices need to adopt in 2012

Submit responses to before Jan. 3.

Related Articles on Pain Management:
Does Acupuncture Have a Place in Western Medicine?
What Can Legislators Do Right Now to Positively Impact Pain Management? 5 Physician Responses
ASC Specialty to Watch: Pain Management in 2012

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